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Introduction: Patients undergoing surgery may need transfusion of blood products for a variety of reasons. Therefore, this study aimed to determine the incidence of blood transfusion complications in patients undergoing surgery. Methods: The present study was performed as a cross-sectional study in 2020 at Shohadaye Tajrish Hospital in Tehran, Iran. A total of 1132 patients who had complications during surgery upon transfusion of blood and blood products from 2015 to 2020 were included in the census. To collect information, a checklist, including patients’ information, the type of product, and types of complications was used. SPSS software version 21 was used for data analysis. Results: In this study, 99.7% of the complications were acute, and in 91.1% of the cases, the severity of complications was mild. Of the confirmed complications, 46.4% were allergic reactions, and 43.8% were reported as non-hemolytic febrile reactions. A total of 91.1% of patients completely recovered after the onset of the complication, 6.2% had a partial disability, 0.4% had severe disability, and 0.3% died. Conclusion: The results showed that most patients had acute complications in terms of the type of complication and mild in terms of the severity, thus a completely regular program is recommended to control side effects related to blood and blood products transfusion.

Background: We aimed to explore the influencing factors of clinical adverse blood transfusion reactions, to provide theoretical basis and support for clinical safe blood transfusion, and to minimize the occurrence of adverse blood transfusion reactions. Methods: The method was to retrospectively analyze the report of adverse blood transfusion reports from 6 hospitals in Linyi area, Shandong, China to the blood station in Linyi City center from 2013 to 2020. We aimed to classify factors, analyze the occurrence of adverse transfusion reactions, and discuss the correlation between the occurrence of adverse transfusion reactions and the above factors. Results: Overall, 248 patients (77.98%) had a history of blood transfusion. The difference between this group and the group with no history was statistically significant (P

BACKGROUND & OBJECTIVES Serologic testing after transfusion reactions (TRs) aims to find accountable immune haemolytic incompatibility. Our hospital policies recommend serologic testing in all TR, except for low-risk fevers (subclinical temperature

There were increased reports of fevers and febrile reactions in young children (particularly children aged5 years) receiving the Seqirus/CSL Southern Hemisphere 2010 trivalent inactivated influenza vaccine (IIV3). Modifying the vaccine manufacturing process by increasing the minimum concentration of splitting agent (sodium taurodeoxycholate [TDOC]) from 0.5% w/v to 1.5% w/v for all strains resolved this issue. The current analysis compared fever rates in three pediatric studies of Seqirus IIV3 (S-IIV3) or quadrivalent inactivated influenza vaccine (S-IIV4), prepared using the modified manufacturing process, with fever rates in three pediatric studies of historical (pre-2010) IIV3 formulations. The historical IIV3 formulations, S-IIV3, and S-IIV4 had 0/3, 2/3, and 4/4 vaccine strains split at 1.5% TDOC, respectively.For each study, fever rates (any grade and severe) were determined for the following age subgroups (as applicable), using the fever intensity grading system used in the S-IIV3/S-IIV4 studies: 6 months to3 years; 3 to5 years; 5 to9 years; and 9 to18 years.For each age subgroup, the any grade and severe fever rates were lower in the S-IIV3/S-IIV4 studies than in the historical IIV3 formulation studies, with the greatest differences in fever rates observed in the youngest age groups. In the 6 months to3 years group, the any grade fever rate was 7.0% (severe fever: 2.5%) in one S-IIV4 study compared with 38.7% to 40.0% (severe fever: 9.6% to 17.8%) in the historical IIV3 formulation studies. In the 3 to5 years subgroup, the any grade fever rate was 4.9% (severe fever: 1.2%) in one S-IIV4 study compared with 34.1% to 36.0% (severe fever: 6.3% to 16.5%) in the historical IIV3 formulation studies.This analysis provides clinical evidence that the modified manufacturing process improved the fever profile across all pediatric age groups, in particular, in children aged5 years.

Influenza vaccine safety is an ongoing issue. In 2010, inactivated trivalent influenza vaccines (TIVs), Fluvax(®) and Fluvax Junior(®) manufactured by CSL Biotherapies ('CSL'), Parkville, Australia, were associated with a marked increase in febrile seizures (FS) in children

Despite the significant strides that have been made to improve the safety of blood product transfusion over the past several decades, there still remain potential risks to the administration of these components. With such adverse events, also termed transfusion reactions, disorders can range from severe and life-threatening to transient and mild. Due to the wide spectrum of disorders that can be associated with transfusion, and the need to intervene to prevent poor outcomes, it is vital that practicing clinical pathologists, blood bankers, and those engaged in the field of hematology have a detailed working knowledge of how to recognize and classify transfusion-associated adverse events. As such, the aims of this chapter are (1) to introduce readers to each of the various common and less frequent types of transfusion reactions, (2) to review the incidence and basic pathophysiology of these adverse events, and (3) to discuss practical approaches to treat and prevent these disorders. We also seek to provide a basic framework on the approach to evaluating transfusion reactions from a general perspective.

In Australia, during the 2010 Southern Hemisphere (SH) influenza season, there was an unexpected increase in post-marketing adverse event reports of febrile seizures (FS) in children under 5 years of age shortly after vaccination with the CSL trivalent influenza vaccine (CSL 2010 SH TIV) compared to previous CSL TIVs and other licensed 2010 SH TIVs. The present study describes the outcomes of a series of in vitro experiments directed at elucidating the root cause. The scientific investigations found that a subset of paediatric donors displayed elevated cytokine/chemokine responses to the CSL 2010 SH TIV but not to previous CSL TIVs nor other 2010 SH TIVs. The induction of elevated cytokines/chemokines in paediatric whole blood correlated with elevated NF-κB activation in a HEK293 cell reporter assay. The data indicate that the introduction of the B/Brisbane/60/2008 strain within the CSL manufacturing process (such as occurred in the preceding 2009/10 NH season) appears to have raised the pyrogenic potential of the CSL 2009/10 NH TIV but that this was insufficient to elicit FS in children

Aggressive treatment with high-dose i.v. melphalan followed by auto-SCT (HDM/SCT) is effective in inducing hematological and clinical remissions, and in extending survival in AL amyloidosis. Tandem cycles of HDM/SCT have been shown to increase hematologic complete response rates in patients with AL amyloidosis. Between April 1994 and July 2008, 57 patients with AL amyloidosis at the Boston University Medical Center were treated with a second cycle of HDM/SCT after failing to achieve a complete response after a first transplantation. A total of 11 of 57 patients (19%) treated with tandem transplantation developed high fever 12-24 h after melphalan administration. The average peak temperature was 39.1 degrees C. Other clinical features include hypotension, acute renal failure and skin rash. No infectious etiology was identified. One of the patients had serum available for measurement of cytokines before, during and after the febrile reaction. The concentration of several pro-inflammatory cytokines, including IL-6 and TNFalpha, increased significantly, showing a clear physiological response correlating with the clinical findings. We conclude that an unusual cytokine-mediated febrile reaction can occur in patients with AL amyloidosis exposed to a second cycle of high-dose melphalan, which we have termed a 'melphalan recall' reaction.

It has become apparent that the crossmatch procedures for the HL-A typing of organs, tissues and leukocytes for transplant and transfusion recipients are assuming a more prognostic role than conventional HL-A typing. Recent data has shown that regardless of the grade of the HL-A match, a positive crossmatch invariably indicates a troublesome clinical course for the patient. The antiglobulin lymphocytotoxicity technique is a relatively new HL-A crossmatch procedure. This technique was evaluated against the NIH standard lymphocytotoxicity test, with standardized HL-A typing sera. Pre- and post-transplant sera from several patients were compared using the two test systems in an attempt to show correlations with clinical courses. In addition, sera from patients who exhibited febrile reactions, which were not attributable to red cell incompatibilities were evaluated for crossmatch and conventional HL-A incompatibilities.

The medical literature contains many articles concerning hemolytic reactions, but few which pertain to “benign” febrile reactions. Febrile reactions have been attributed to pyrogens, to plasma factors, to isosensitizations and now to leukoagglutinins. It is the opinion of many physicians that febrile reactions occur only in relatively few cases.From October 1947 to September 1957, a total of 1199 transfusions were performed at the Blood Bank of Hawaii. The total febrile reaction rate was 4.4%, the allergic reaction rate 4.6 %.This study will show the reaction rates for recipients of one, two to five, and more than five transfusions. The difference in reactions following whole blood and red cell mass will also be described. A comparison of this report obtained at first hand, and as obtained from hospitals, will be made.

Electroconvulsive therapy is a widely practiced, safe and effective treatment for severe mental illness. A febrile reaction induced by electroconvulsive therapy is rarely reported as an adverse effect. We present a 15-year old Chinese girl with first episode catatonic schizophrenia who developed recurrent febrile reactions after electroconvulsive therapy. Vigilant clinical monitoring and laboratory tests are necessary in the management of these cases. The natural course of fever, clinical characteristics and suspected risk factors of this case were discussed.

Background . Universal leukodepletion of blood components to prevent acute non-hemolytic transfusion reactions (NHTRs) is still a subject of debate. Patients and methods . Transfusion-associated NHTRs observed at our hospital in the last 6 years were retrospectively analyzed. Buffy-coat depleted red blood cells (bc-RBCs), and if indicated, leucodepleted post-storage (ld-RBCs) were initially used. In April 1997, universal leukodepletion was implemented at our hospital, and thereafter only prestorage ld-RBCs were used. All platelet concentrates transfused during this time were prestorage filtered single-donor apheresis platelets (SDAPs). Results . A total of 163,090 blood products were transfused from April 1995 to April 2001 (bc-RBC: n =34,040 units; ld-RBC: n =66,967; SDAP: n =14,516; FFP: n =47,567). The number of post-transfusion febrile NHTRs occurring with each blood product was 65 (0.19%) for bc-RBCs, 8 (0.16%) for post-storage ld-RBCs, 16 (0.03%) for prestorage ld-RBCs, 16 (0.11%) for SDAPs, and 10 (0.02%) for FFP. Allergic reactions ( n =116) were most frequently observed after SDAP transfusion (0.32%) and occurred at a similarly low rate after transfusion of all other blood components (0.03–0.08%). Conclusion . In conclusion, acute NHTRs rarely occur after the use of leukodepleted blood components. Prestorage appears to be more effective than post-storage leukodepletion in preventing febrile reactions following a blood transfusion.

Febrile and allergic transfusion reactions are well-known side effects after transfusion of platelet concentrates. Febrile reactions are regularly accompanied by chills and rigor. Allergic reactions a

Granulocyte transfusions may be useful for neutropenic pediatric patients with refractory bacterial or fungal infections. Many potential adverse sequelae associated with granulocyte transfusions are well recognized, including febrile reactions, fluid overload, alloimmunization, and lung injury. Other potential adverse sequelae, however, are less well known. This case report describes an infant with familial hemophagocytic lymphohistiocytosis who developed polycythemia (hemoglobin 10-17.6 g/dl) following four daily transfusions of 20 ml/kg of apheresis collected, steroid stimulated donor granulocytes. Expanded knowledge of potential risks of transfused granulocytes will allow for rapid recognition of transfusion-related complications, should they occur.

The last 20 years have seen many advances in transfusion therapy and safety. Blood products are biological products engendering complex interactions with the immune system. Prestorage leukoreduction results in a reduced risk of febrile reactions, CMV transmission, and immune modulation, proving to be safer for patients than non-leuko reduced products.

Summary Leucocyte counts of < 5 · 10 6 per blood transfusion product are currently recommended in the UK in order to reduce transfusion-related infections and febrile reactions. Routine leucocyte depletion, however, requires the development of reliable internal and external quality assurance (EQA) programmes. We report preliminary findings from the UK NEQAS for Low-Level Leucocyte Counting from 18 UK Transfusion Centres over a four month period. Data analysis showed that the IMAGN 2000 had the lowest CVs (range 7.5‐36%, mean 16.7) for samples with counts of 5‐30 cells/ll when compared to the flow cytometric (range 13.8‐88%, mean 29.5) and Nageotte methods (range 20.6‐117%, mean 61.8). In addition, laboratories using commercial nuclear stains (LeucoCOUNT TM ) had consistently lower CVs than those using ‘in-house’ propidium iodide staining methods. Important differences in flow cytometric gating strategies were also identified. This study highlights the current variability in low level leucocyte counting, especially within the critical range of 5‐30 cells/ll (equating to < 5 · 10 6 /l). The acceptance of consensus protocols, including gating strategies and nuclear staining techniques, is required to reduce the observed interlaboratory variation. Finally, we demonstrate that stabilized blood preparations can be successfully used to provide a national/international low-level leucocyte EQA scheme.

Data from the literature report febrile reactions prior to myocardial infarction in patients with normal coronary arteries and that coronary syndromes seem to be triggered by bacterial and viral infections, being fever the common symptom. The thermo-mechanical behavior of thoracic aortas of New Zealand White rabbits with different degrees of atherosclerosis was measured by means of pressure-diameter tests at different temperatures. Specific measurements of the thermal dilatation coefficient of atheroma plaques were performed by means of tensile tests. Results show a different thermo-mechanical behavior, the dilatation coefficient of atheroma plaque being at least twice that of the arterial wall. Temperature-induced mechanical stress at the plaque-vessel interface could be enough to promote plaque rupture. Therefore, increases of corporal temperature, either local or systemic, can play a role in increasing the risk of acute coronary syndromes and deserve a more comprehensive study.

Dry platelets are required to prevent hemolytic and nonhemolytic febrile reactions after transfusion to ABO mismatched recipients, to reduce the risk of HLA immunization and to prevent allergic or anaphylactic reactions. Previously we have shown that the collection of single donor platelets almost free of plasma is possible with different cell separators. With the systems we described for the CS 3000+/Amicus and AS 104–204 apparatuses collection of dry platelets implies their resuspension in non plasma solutions after opening the circuit. With the new system developed by Dideco for the Excel apparatus this moreover is no longer required since the platelet bag can be connected to the resuspending medium through a dedicated line with an antibacterial filter. Platelets are collected cyclically and the resuspending solution is added when the procedure is over. In this study 53 collections were evaluated, 21 of which were erythrothrombocytapheresis. In 60–65 min 4.2 l of anticoagulated blood (1/12) were processed with platelet collection automatically done after 6–700 ml cycles. The platelet yield averaged 4.67 ± 0.7 × 10 11 , with a platelet efficiency per minute of 7.18 ± 0.9 × 10 9 . The WBC contamination averaged 2.6 ± 0.7 × 10 5 and contamination did not exceed 0.87 × 10 6 . The quality of platelets was satisfactory as measured by aggregation, morphology score, and CD 62 membrane glycoprotein externalization. These results were comparable to those obtained with three other Excel apparatuses used in the conventional way to collect platelets resuspended in plasma or with the Amicus used to collect dry platelets using an open system.

Although platelet transfusions provided in developed countries are generally of good quality, a number of challenges remain. Can we reduce the viral risk any further and what should we do to detect bacterial contamination? Can unpleasant febrile reactions be eliminated? How should we evaluate novel technologies for platelet production, and do we know how to assess their relative merits if, for example, a technique for viral inactivation affects platelet function? Providing ‘assurance’ of both safety and efficacy operates at several levels at the stage of policy setting for testing and production, when novel technologies are evaluated, and as an ongoing process during routine production. Each stage of quality assurance requires a different strategy. A battery of assays appropriate to assessment of a completely new technology, for example, would be too expensive and impracticable for routine use. Similarly, there needs to be good evidence that measurements employed routinely are the best surrogate for platelet function in vivo. This paper will review the current strategies for ensuring that platelets are as safe and efficacious as possible; along with some of their limitations.

In Australia, during the 2010 Southern Hemisphere (SH) influenza season, there was an unexpected increase in post-marketing adverse event reports of febrile seizures (FS) in children under 5 years of age shortly after vaccination with the CSL 2010 SH trivalent influenza vaccine (CSL 2010 SH TIV) compared to previous CSL TIVs and other licensed 2010 SH TIVs. In an accompanying study, we described the contribution to these adverse events of the 2010 SH influenza strains as expressed in the CSL 2010 SH TIV using in vitro cytokine/chemokine secretion from whole blood cells and induction of NF-κB activation in HEK293 reporter cells. The aim of the present study was to identify the root cause components that elicited the elevated cytokine/chemokine and NF-κB signature. Our studies demonstrated that the pyrogenic signal was associated with a heat-labile, viral-derived component(s) in the CSL 2010 SH TIV. Further, it was found that viral lipid-mediated delivery of short, fragmented viral RNA was the key trigger for the increased cytokine/chemokine secretion and NF-κB activation. It is likely that the FS reported in children

Cutaneous drug reactions account for a large proportion of adverse drug reactions. Cutaneous drug reactions can be very challenging to diagnose. They can mimic many other skin diseases; this is especially evident during childhood, when viral exanthems are commonplace. Also, if a patient is taking numerous medications, establishing causality to a specific drug can be multifaceted and difficult. The purpose of this review is to highlight an approach to the diagnosis of a suspected cutaneous drug reaction in a child. We have classified different types of drug eruptions by morphology: exanthematous, urticarial, pustular, and bullous. Within each of these groups we have divided them into simple, benign, or non-febrile and complex or febrile reactions. We also include a miscellaneous group to ensure a methodical review.

There are limited summary data published on the risk of fever and febrile seizures in children following influenza vaccination. We performed a review of the risk of fever and febrile seizures following receipt of trivalent inactivated influenza vaccine (TIV) in children aged ≥6 months to

Water treatment is a vital aspect of hemodialysis in which knowledge and technical skills are of utmost importance. The recognition that nontuberculous mycobacteria can be resistant to certain germicides spurred the establishment of the current safety microbiologic standards for dialyzer reprocessing. Monitoring the dialyzer membrane integrity is as important as meeting the standards for bacterial and endotoxin levels for dialyzer reprocessing. Ensuring the use of product water that meets the chemical and microbiologic standards of the Association for the Advancement of Medical Instrumentation is necessary to reduce the incidence of endotoxemia and chemical hazards associated with the use of water for hemodialysis. The pathogenesis of febrile reactions during hemodialysis remains controversial. The weight of evidence, however, favors transmission of endotoxin fragments across dialysis membranes to induce mononuclear cell cytokine production.

Many of the risks and discomforts associated with blood transfusion may be avoided by removing the contaminating leukocytes from cellular blood components. Leukocyte reduction prevents many febrile reactions that occasionally occur following red cell transfusion and prevents some febrile reactions following platelet transfusion. Prophylactic use of leukocyte-reduced components may prevent primary HLA alloimmunization, which is a principle cause of the refractoriness to platelet transfusion seen in many multiply transfused, thrombocytopenic patients. Leukocyte-reduced components are equally effective in the prevention of CMV as seronegative blood.

During the 2010 Southern Hemisphere (SH) influenza season, there was an unexpected increase in the number of febrile reactions reported in the paediatric population in Australia shortly after vaccination with the CSL 2010 trivalent influenza vaccine (TIV) compared to previous seasons. A series of scientific investigations were initiated to identify the root cause of these adverse events, including in vitro cytokine/chemokine assays following stimulation of adult and paediatric whole blood, as well as mammalian cell lines and primary cells, profiling of molecular signatures using microarrays, and in vivo studies in rabbits, ferrets, new born rats and rhesus non-human primates (NHPs). Various TIVs (approved commercial vaccines as well as re-engineered TIVs) and their individual monovalent pool harvest (MPH) components were examined in these assays and in animal models. Although the scientific investigations are ongoing, the current working hypothesis is that the increase in febrile adverse events reported in Australia after vaccination with the CSL 2010 SH TIV may be due to a combination of both the introduction of three entirely new strains in the CSL 2010 SH TIV, and differences in the manufacturing processes used to manufacture CSL TIVs compared to other licensed TIVs on the market. Identification of the causal component(s) may result in the identification of surrogate assays that can assist in the formulation of TIVs to minimise the future incidence of febrile reactions in the paediatric population.

We closely observed 86 transfusions to multitransfused hematologic patients with leukocyte-depleted platelet concentrates (PCs) prepared from buffy coats (BC PCs), filtered either prior to storage (BC1) or after 3-4 days' storage (BC3). The patients were first given, randomly, either BC1 or BC3, and were thereafter used as their own controls by giving them the two BC types alternately. The results were compared with an earlier study on standard platelet-rich plasma (PRP) PCs (46 transfusions to 23 patients) and leukocyte-depleted PRP PCs (23 transfusions to 12 patients). There was no difference in adverse reactions between BC1 and BC3 PCs, but BC PCs caused significantly fewer and milder adverse reactions than PRP PCs. Febrile reactions (FTR) occurred in 4.6%, urticarial skin reactions in 21%, and pulmonary reactions in 0% of BC PC transfusions (17, 29 and 0% of patients). The mean corrected increments (CI) at 16-18 h were higher after BC1 PCs than BC3 PCs (10.3 vs. 8.0, p = 0.046). We conclude that adverse reactions are reduced by use of BC PCs. Prestorage leukocyte depletion may improve platelet increments.

Reduction of leucocytes in blood components, achieved by filtration, may reduce the risk of HLA alloimmunization, virus transmission, and febrile reactions. Nevertheless, white blood cell (WBC) concentrations obtained in this way can be too low to be accurately counted with automated and manual techniques. We describe here a rapid, reliable, and very sensitive method for counting low leucocyte numbers using flow cytometry. WBC nuclei are labelled by propidium iodide. A known amount of fluorescein- and phycoerythrin-conjugated beads (Standard Brite, Coulter) is added as an indicator of the examined volume. The time required for analyzing one tube is approximately 5 min. This method was first validated by comparing WBC counts (120-2,570/microliters) assessed on a haemocytometer (Bürker) and by flow cytometry. The second step was to determine the sensitivity of the method: we diluted normal platelet concentrates with phosphate-buffered saline. The comparison of expected with observed values showed a very good correlation up to a concentration of 1 WBC/microliter. This technique is an accurate method that can be applied in blood bank quality controls and in clinical studies.

Experiments on rabbits showed that, in the course of a febrile reaction, alterations in the activities of the kallikrein-kinin, proteolytic, and antiproteolytic systems of the lymph and blood are of a systemic nature, i.e., they occur in all components of humoral transport, attesting to the close interrelationship and unity of these systems in body fluids. Depending on the duration of the febrile reaction, the time course of these systems' components was characterized by phasic increases and decreases in their activity.

BACKGROUND The reduction of white cells in blood components before transfusion by filters with at least 3 log10 depletion may prevent adverse transfusion reactions such as HLA alloimmunization, febrile reactions, transmitted infections, and immunomodulation. A new generation of filters with 4 log10 depletion is now available. STUDY DESIGN AND METHODS The aim of this study is to compare the efficiency of white cell reduction by six commercial filters for packed red cells with 3 and 4 log10 depletion (claimed by manufacturers). The analysis of white cell concentration in the white cell-reduced units was performed by flow cytometry and with a Nageotte chamber. RESULTS The last generation of filters (BPF4, RC400, R01 Plus) show mean residual white cell numbers of 0.18 +/- 0.14, 0.26 +/- 0.21, and 0.25 +/- 0.15 x 10(6), respectively, by flow cytometric analysis and 0.05 +/- 0.04, 0.18 +/- 0.15, and 0.38 +/- 0.23 x 10(6), respectively, by Nageotte chamber evaluation. The 3 log10 depletion filters (R01, Leucostop-4LT-mono, R200) have mean residual white cell numbers of 1.41 +/- 0.92, 2.4 +/- 1.99, and 1.05 +/- 0.64 x 10(6), respectively, by flow cytometric analysis and 3.56 +/- 1.7, 1.67 +/- 1.3, and 3.21 +/- 4.1 x 10(6), respectively, by Nageotte chamber evaluation. The data show that the BPF4, RC400, and R01 Plus filters are likely to be more efficient by 1 log10 reduction than the R01, Leucostop-4LT-mono, and R200 filters. CONCLUSION The most recent generation of filters is able to deplete white cells from packed red cells by 4 log10; in particular, with one of the filters, the residual WBC content was less than 0.5 x 10(6) per unit in all experiments, while two other filters reached that level in 9 of 10 experiments.

S controversy exists as to whether the United States should require that all transfused red blood cells (RBCs) and platelets have 99.91% of residual white blood cells (WBCs) removed by filtration (universal leukocyte reduction [ULR]), regardless of the intended recipient’s medical history.1–9 Great Britain and Canada instituted ULR in 1999,6 in part for theoretical concerns about blood transmission of variant Creutzfeldt-Jakob disease. Not only is there no human evidence for such transmission, but there is no evidence that ULR filtration renders blood or fluids noninfectious for variant Creutzfeldt-Jakob disease. This article will outline the ULR medical debates, consider the appropriateness of such regulation, review the choices associated with this potential blood safety improvement, and discuss supply and economic implications. Under ULR, all platelets and RBCs available from blood centers will be leukoreduced (LR). This change results both from new Food and Drug Administration (FDA) quality control standards affecting bedside LR blood products and from the desire of blood centers to have only 1 type of inventory. The primary established advantage of LR blood products is reduced rates of alloimmunization to WBCs and platelets. Such reduction is desirable for patients undergoing repeated transfusions of platelets, particularly those with hematologic malignancies. Alloimmunization is a major cause of lower in vivo yield of platelet transfusions and reduces the success rate of allogeneic bone marrow transplants. Avoiding alloimmunization and WBC cytokines also should lower the frequency of febrile transfusion reactions. Again, the clear benefit is primarily for patients receiving repeated transfusions, including some with nonmalignant hematologic disorders, such as hemoglobinopathies, as well as those with malignancies. Unfortunately, while WBC cytokines induce fevers, many transfusion-associated fevers occur for other coincidental reasons, and findings for all patients are not clear cut. This problem is seen in 2 reports from large transfusion services comparing preand post-ULR febrile reactions. One brief note cited a more than 90% rate reduction with ULR,2 and the other, a full article, had a statistically insignificant change from 0.12% to 0.08% of transfusions.9

Background: Voluntary Adult blood donor panel is low in Nigeria. Sickle cell disease (SCD) is a common chronic disease which requires regular blood transfusion. Cord blood has been shown to be physiologically suitable as an alternative to adult blood transfusion. Aim: To assess the knowledge and acceptance of cord blood transfusion as an alternative to adult blood in SCD patients. Design and methods: A descriptive study was carried out from March to May 2009. Subjects included SCD patients recruited from the university of Benin teaching hospital and the sickle cell centre in Benin City. Interviewer administered questionnaires were used to assess SCD patients' awareness and acceptance of cord blood as an alternative to adult blood for transfusion purposes. Results: A total of 125 SCD patients who completely filled and returned questionnaire were analyzed. None of the patients had knowledge of use of cord blood as an alternative for adult blood transfusion but Eighty-three percent of respondents (104/125) also had no previous knowledge of use of cord blood for stem cell transplantation. Sixty-six, (66/125) 58.8% of respondents would accept cord blood transfusion while 47.2% would not. The main reason for rejecting cord blood was found to be fear of medical complications 44/59(74.5%). Sixty-one percent of respondents were transfused 2-3 times in the preceding 12 months. The most frequent transfusion reaction observed was febrile reactions (51.5%) followed by urticaria (22.2%). Conclusion: This study has shown that majority of the respondents will accept cord blood transfusion. The main reason for rejecting cord blood transfusion was fear of medical complications. More patients will accept cord blood transfusion if adequately counseled. Key words: Adult blood transfusion, Sickle cell disease and Cord blood transfusion.

The 2010 trivalent influenza vaccine (TIV) manufactured by CSL Biotherapies (CSL) was associated with increased febrile reactions, including febrile convulsions, among Australian children. CSL is one of the few manufacturers that use deoxycholate as the virus-splitting agent in the manufacture of TIV. Clusters of adverse events following immunisation (AEFI) have been previously linked to other deoxycholate-split TIV formulations in Europe and Canada. We hypothesise that suboptimal virus splitting or other mechanisms related to the use of deoxycholate may have played a role in adverse events linked to the 2010 CSL TIV. This hypothesis garners support from a recent United States Food and Drug Administration warning letter indicating that CSL failed to determine optimal splitting conditions for new virus strains and that assays to assess virus splitting had not been validated. While there may be other causes, the use of deoxycholate should be further explored. Comprehensive and timely investigations of AEFI, especially those involving children, are necessary to prevent their recurrence and to maintain public confidence in vaccination programs.

Background The 2010 influenza vaccination program for children aged 6 months to 4 years in Western Australia (WA) was suspended following reports of severe febrile reactions, including febrile convulsions, following vaccination with trivalent inactivated influenza vaccine (TIV). Methods To investigate the association between severe febrile reactions and TIV, three studies were conducted: (i) rates of febrile convulsions within 72 h of receiving TIV in 2010 were estimated by vaccine formulation and batch; (ii) numbers of children presenting to hospital emergency departments with febrile convulsions from 2008 to 2010 were compared; and (iii) a retrospective cohort study of 360 children was conducted to compare the reactogenicity of available TIV formulations. Findings In 2010, an estimated maximum of 18 816 doses of TIV were administered and 63 febrile convulsions were recorded, giving an estimated rate of 3.3 (95% CI 2.6 to 4.2) per 1000 doses of TIV administered. The odds of a TIV-associated febrile convulsion was highly elevated in 2010 (p, Article summary Article focus Soon after commencement of the 2010 paediatric influenza vaccination program in Western Australia (WA), clinicians noted an apparent increase in children presenting with fever, vomiting and occasionally febrile convulsions, which led to a temporary suspension of the WA program for children under 5 years of age. Three separate analytical studies were undertaken to determine the association between severe febrile adverse events and administration of the 2010 trivalent inactivated influenza vaccine (TIV) to children aged 6 months through 4 years in WA. Key messages The estimated rate of febrile convulsions in children aged under 5 years related to receipt of the 2010 TIV was found to be 3.3 per 1000 doses, more than 200 times higher than the only population-based published estimate. Of the two major brands of TIV used in the program prior to its suspension, the elevated risk of febrile convulsions and other febrile reactions was found to be clearly associated with the Fluvax and Fluvax Junior formulations, manufactured by CSL Biotherapies; the reactions do not appear to be associated with the other TIV formulation. As the biological mechanism has, to date, not been definitively identified, it seems reasonable that countries implement paediatric vaccination programs as usual using vaccine brands other than those of CSL Biotherapies, and undertake enhanced surveillance for febrile reactions and other adverse events in all children under 5 years of age receiving TIV. Strengths and limitations The major limitation of this study is the absence of reliable prospective data from an established, timely surveillance system designed to monitor adverse events resulting from vaccination. Accordingly, several data sources were used to gather numerator and denominator data, some already established and some created ad hoc and requiring retrospective data collection. Its strengths are, first, the consistency of findings using different data sources and the strength of the statistical associations found, and second, the fact that this is the first report of an elevated rate of severe febrile reactions to TIV in children.

Symptoms of fever and/or rigours after transfusion continue to occur commonly in patients receiving platelets leucocyte-reduced after storage. A cohort of 24 consecutive patients who had experienced severe or repeated febrile nonhaemolytic reactions to post-storage leucocyte-reduced platelet transfusions were treated with saline-washed, post-storage leucocyte-reduced platelets. The frequency of reactions declined from 20% of transfusions (n = 191) to 0.6% (n = 331) after instituting saline-washed, post-storage leucocyte-reduced platelet transfusions. These results support the hypothesis that substances present in the supernatant of stored platelet concentrates mediate febrile nonhaemolytic transfusion reactions, and provide one strategy for preventing their occurrence.